DOI: https://doi.org/10.36347/sjmcr.2026.v14i10.020

Pages: 2206-2209

Background: Extra-uterine leiomyomatosis is a rare benign condition characterized by the proliferation of smooth muscle cells outside the uterus. Its clinical presentation is often misleading and may mimic malignant pelvic disease, particularly in patients with a history of uterine surgery. Case presentation: We report the case of a 59-year-old woman with a history of total hysterectomy performed 15 years earlier for uterine fibroids. She presented with chronic pelvic pain, constipation, and urinary symptoms. Imaging revealed a large, multinodular pelvic mass causing significant mass effect on adjacent organs. Laparoscopic exploration identified multiple disseminated leiomyomatous nodules within the pelvis. Complete surgical excision with bilateral adnexectomy was performed. Histopathological examination confirmed benign smooth muscle proliferation with no atypia, necrosis, or mitotic activity, and a low Ki-67 index. Conclusion: Extra-uterine leiomyomatosis should be considered in the differential diagnosis of pelvic masses in patients with a history of uterine surgery. Long-term follow-up is essential due to the risk of recurrence and the rare possibility of malignant transformation.